MEDICARE: CHAREEN L FOUNTAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1306677703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAREEN L FOUNTAIN

Provider Business Mailing Address
First Line	:	1106 MOUNT VERNON BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-3658
Country	:	US
Telephone Number	:	216-347-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 MOUNT VERNON BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-3658
Country	:	US
Telephone Number	:	216-347-0238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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Directions to “ CHAREEN L FOUNTAIN ” Practice Location

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